title: Does continuity of care impact decision making in the next birth after a caesarean section (VBAC)? a randomised controlled trial.
abstract: BACKGROUND
  Caesarean section (CS) has short and long-term health effects for both the woman and her baby. One of the greatest contributors to the CS rate is elective repeat CS. Vaginal birth after caesarean (VBAC) is an option for many women; despite this the proportion of women attempting VBAC remains low. Potentially the relationship that women have with their healthcare professional may have a major influence on the uptake of VBAC. Models of service delivery, which enable an individual approach to care, may make a difference to the uptake of VBAC. Midwifery continuity of care could be an effective model to encourage and support women to choose VBAC.
  
  
  METHODS
  A randomised, controlled trial will be undertaken. Eligible pregnant women, whose most recent previous birth was by lower-segment CS, will be randomly allocated 1:1 to an intervention group or control group. The intervention provides midwifery continuity of care to women through pregnancy, labour, birth and early postnatal care. The control group will receive standard hospital care from different midwives through pregnancy, labour, birth and early postnatal care. Both groups will receive an obstetric consultation during pregnancy and at any other time if required. Clinical care will follow the same guidelines in both groups.
  
  
  CONCLUSIONS
  This study will determine whether midwifery continuity of care influences the decision to attempt a VBAC and impacts on mode of birth, maternal experiences with care and the health of the neonate. Outcomes from this study might influence the way maternity care is provided to this group of women and thus impact on the CS rate. This information will provide high level evidence to policy makers, health service managers and practitioners who are working towards addressing the increased rate of CS.
  
  
  BACKGROUND
  This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12611001214921.
authors.affiliation: Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology, Level 7, 235-253 Jones St, Broadway, Sydney, NSW, Australia. caroline.homer@uts.edu.au
authors.forename: Caroline S E
authors.initials: CS
authors.lastname: Homer
authors.forename: Karyn
authors.initials: K
authors.lastname: Besley
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bell
authors.forename: Deborah
authors.initials: D
authors.lastname: Davis
authors.forename: Jon
authors.initials: J
authors.lastname: Adams
authors.forename: Alison
authors.initials: A
authors.lastname: Porteous
authors.forename: Maralyn
authors.initials: M
authors.lastname: Foureur
mesh_terms: D003266:Continuity of Patient Care; D003657:Decision Making; D005260:Female; D006801:Humans; D008880:Midwifery; D011247:Pregnancy; D011369:Professional-Patient Relations; D012107:Research Design; D016064:Vaginal Birth after Cesarean / Q000523:psychology*